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Correlation of Molecular Genetics with Molecular and Morphological Imaging in Gliomas with an Oligodendroglial Component

¹ JK Douglas Laboratories and ² Clatterbridge Centre for Oncology, Clatterbridge Hospital, Bebington, Wirral, United Kingdom; ³ Walton Centre for Neurology and Neurosurgery, and ⁴ Department of Neurological Science, University of Liverpool, Liverpool, United Kingdom; and ⁵ Department of Nuclear Medicine, Royal Liverpool University Hospital, Liverpool, United Kingdom

Purpose: Since the recognition that oligodendrogliomas may be chemosensitive, their diagnosis and clinical management has become highly controversial. Histopathology diagnosis remains challenging and new tools such as molecular genetics or molecular imaging require evaluation.

Experimental Design: In a single-center, population-based prospective study, allelic imbalance in chromosomes 1p36, 19q13, 17p13, 10p12–15, and 10q22–26 has been investigated in 19 oligodendroglioma WHO grade 2 (OII), 20 oligoastrocytoma WHO grade 2 (OAII), 8 oligodendroglioma WHO grade 3 (OIII), and 12 oligoastrocytoma WHO grade 3 (OAIII), and compared with pretherapy histopathology, computed tomography and/or magnetic resonance (CT and/or MR), [fluorine-18]fluoro-2-deoxyglucose (¹⁸F-FDG), and thallium-201 single-photon emission computed tomography (²⁰¹Tl SPECT).

Results: In 50 cases, ¹⁸F-FDG uptake correlated with ²⁰¹Tl uptake; however, 8 cases had increased ²⁰¹Tl uptake but were hypometabolic for ¹⁸F-FDG, and 1 case was hypermetabolic with normal ²⁰¹Tl uptake. Sixteen cases enhanced on CT/MR but failed to show ²⁰¹Tl uptake; and 2 low-grade non-enhancing oligodendrogliomas had increased ²⁰¹Tl uptake. Increased metabolism was more likely in high-grade cases, with ²⁰¹Tl uptake more strongly correlated with grade than was ¹⁸F-FDG uptake. Tumors with 1p/19q loss were more likely to show increased ²⁰¹Tl uptake and, to a lesser degree, increased ¹⁸F-FDG uptake than those without these losses. Elevated metabolism in 28% of low-grade tumors was significantly more common in tumors with 1p/19q loss, and increased uptake of both ¹⁸F-FDG and ²⁰¹Tl in low-grade cases was found only in those with 1p/19q loss.

Conclusions: In this study, dissociation of uptake of contrast agents and radiotracers suggests independent deregulation of the blood–brain barrier breakdown and metabolism during disease progression of oligodendroglial neoplasms, and the association of elevated metabolism with 1p/19q loss, particularly in low-grade tumors, may have implications for clinical management.

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